Introduction: An industrial plant located in the northeast of Rome, Italy, has been manufacturing and recycling chemical catalysts and refining platinum group metals since 1956. Over time, the industrial area has been embedded within the city increasing risk perception among the population. Several studies have pointed out the adverse effect of industrial air pollution on pregnancy outcomes. We studied the reproductive health in women residing close to the plant incinerator using two exposure indicators (residential proximity and air pollutants derived from a dispersion model). Methods: For all mothers residing within 7km from the incinerator data on births during the period 2001-2012 were retrieved from the Hospital Birth Registry. Residential proximity was defined using 1Km buffers with increasing distance from the incinerator. A Lagrangian dispersion model was carried out to estimate residential exposure to SOx and this was categorized into four levels (<50°pct; 50°-70°pct; 70°-90°pct; ≥90°pct). Outcomes studied were: prevalence of males, preterm birth, small for gestational age (SGA), twin births and congenital anomalies diagnosed at birth. A Poisson regression model was performed adjusting for traffic, maternal education, place of birth and age. Results: The study area had a twofold increase in births compared to Rome (15%vs7%) and we analyzed 37939 newborns. 4% of them lived within 2km from the incinerator with maximum levels of SOx. We found a weak association with residential proximity and SGA (0-1Km vs 4-7Km: RR=1.42;95%CI:0.98-2.08) and twin births (0-3Km vs 4-7Km: RR=1.17;95%CI:0.97-1.40). An increase in the risk of cardiac congenital anomaly was observed for increases in SOx exposure ( ≥90°pct vs <50°pct: RR=1.47;95%CI:1.00–2.16). Conclusions: Exposure to industrial pollution during pregnancy might be a risk factor for child health. Further analysis to better-characterize parental risk factors may increase the strength of findings.